UNNATURAL CAUSES is inequality making us sick? HEALTH EQUITY research topics and resources to learn more
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Income & Wealth

Background: Perhaps the biggest predictor of one's health is one's wealth. It's not just the poor who are suffering; every step down the class pyramid corresponds to worse health. Study after study has shown that those at the top of the class pyramid live on average longer, healthier lives than the rest of us. The middle classes fare worse than those on the top, and the poor get sick more often and die sooner.

The greater the inequality in a society, the steeper the gradient. Currently, the United States has the greatest inequality among rich countries - and the worst health inequities. People in the middle are twice as likely to die prematurely (before age 65) as those on top; people at the bottom are three times as likely.

The life expectancy of American men in the highest income group is 8 years longer than for men in the lowest income group, two and a half years longer than for the second highest income group. Wealthy women live almost 7 years longer than poor women. Children in low-income families are seven times as likely to be in poor or fair health as those in high-income families. Poorer adults are three times as likely to have a chronic disease that limits their activity; twice as likely to have diabetes, and are nearly 50% as likely to die of heart disease.

Wealth doesn't just bring more material comfort, it also provides financial security and access to resources that promote opportunities for better health. Higher income affects health at every age, from the beginning of life to adulthood and old age. For adults, wealth is tied to neighborhood quality, work conditions, food security, access to medical care, and the availability of buffers against stress.

For children, the impact of advantages or disadvantages is even greater, because the effect on health is cumulative. The greater proportion of life one spends at the upper end of the class spectrum, the more benefits accrue. Children from affluent families are more likely to grow up in a house owned by their parents and to live in a neighborhood with healthy food options, safe places to play, good schools, libraries and other quality public services all of which help set them on the path to a successful, healthy life.

Children from less affluent families not only lack these advantages, they are more likely to experience conditions that limit their health and ultimately their life chances: injuries, inadequate or delayed health care, physical inactivity, poor nutrition, insecure or substandard housing, and exposure to toxins, high lead levels and violence. The influence of wealth on health begins even before a child is born, shaping the quality of prenatal care an expectant woman receives, her level of stress during pregnancy and her likelihood of delivering a premature or low birth weight baby.

Wealth is an important determinant of health because it has such a profound effect on other conditions. Yet at every socioeconomic level, African Americans, Native Americans and other people of color fare worse than their white counterparts. Racism as a stress factor independent of class partially explains this, but racism for example, in the form of residential segregation or job discrimination also directly affects wealth.

Today, the wealth gap in America is growing. The average CEO makes more than 250 times the average workers salary, and the top 1% of American households holds more wealth than the bottom 90% combined. In the last 25 years, the income of top earners has increased 81%, while wages for those on the low end of the pay scale have stagnated or declined.

Our health has followed suit. In 1980, the U.S. ranked 14th in the world for life expectancy. In 2007 we ranked 29th. One out of every five American children lives in poverty. Many of the countries that rank higher than we do have policies that protect workers, support families, and provide a safety net for their citizens. These policies typically address income and wealth inequality in one of two ways: (1) they reduce the overall gap so that everyone has sufficient resources to prosper and maintain control over their lives or (2) they loosen the connection between health and wealth by making certain resources available to everyone, not dependent on a family's individual assets.

Examples of policies to reduce the gap include a guaranteed living wage, earned income tax credits, family supports, guaranteed paid vacation and sick leave, secure pensions, and severance pay and job training for unemployed workers. Examples of policies to loosen the wealth-health relationship include universal preschool, better land use and zoning policies, school financing reform, universal health insurance, and stronger environmental protections and better enforcement.

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Image Thumbnail 10 Things to Know about Health (pdf) E-mail to a friend
UNNATURAL CAUSES, 2008

A two-page handout that briefly describes ten key messages about health equity, as  presented in the PBS series UNNATURAL CAUSES, useful for spurring discussion and raising awareness.

Image Thumbnail 1998 Independent Inquiry into Inequalities in Health (aka Acheson Report) E-mail to a friend
REPORT

In the United Kingdom, the 1998 Independent Inquiry into Inequalities in Health Report (otherwise known as the Acheson Report) concluded with 39 policy recommendations to improve health.

Image Thumbnail A Tale of Two Smokers E-mail to a friend
ONLINE INTERACTIVITY based on UNNATURAL CAUSES

Two people, one rich and one poor, are told by their doctor to stop smoking and lose 30 pounds in six months. See the challenges they face as they try to follow their doctor’s orders.

Image Thumbnail Accumulating Advantage E-mail to a friend
ONLINE INTERACTIVITY based on UNNATURAL CAUSES

How do racism and class status get under the skin? How simple is it to just "brush off" experiences with racism? Try this exercise to measure what you are able to take for granted (or not) in your life, and learn how these relate to health.

Image Thumbnail ACORN's Living Wage Resource Center E-mail to a friend
WEB SITE

Contains a brief history of the national living wage movement, background materials such as ordinance summaries and comparisons, drafting tips, research summaries, talking points, and links to other living wage-related sites. (Please also visit www.raisewages.org for the latest on minimum wage ballot initiatives across the country.)

Image Thumbnail Addressing Poverty in TB Control: Options for National TB Control Programmes E-mail to a friend
REPORT from the World Health Organization, 2005

WHO's commitment to the promotion of equity and pro-poor policies in its disease prevention and control activities is based on the recognition of poverty as a major barrier to health and health care. In the case of tuberculosis (TB), the links between poverty and disease burden have been documented for many years. This document addresses the integration of national TB control programmes on the practical issues involved and options for action.

Image Thumbnail American Dream a Nightmare for Many Blacks: study E-mail to a friend
NEWS ARTICLE, Reuters, November 13, 2007

"Black Americans are failing to climb the social ladder, while a worrying number born into the middle classes are now actually poorer than their parents, according to a study released on Tuesday. The report by Brookings Institution scholar Julia Isaacs found blacks were missing out on a cherished American dream that their children will be economically better off...."

Image Thumbnail American Human Development Project E-mail to a friend
WEB SITE

The American Human Development Project is a nonpartisan, non-profit initiative established to introduce to the United States a well-honed international approach and tool for measuring human well-being: the human development approach and the human development index. The project’s mission is to stimulate fact-based public debate about and political attention to human development issues in the United States and to empower people with an instrument to hold elected officials accountable for progress on issues we all care about: health, education and income.

Image Thumbnail Anthony Iton Interview (pdf) E-mail to a friend
EDITED INTERVIEW TRANSCRIPT, Web-exclusive content from UNNATURAL CAUSES

In this original interview, Anthony Iton, director of the Alameda County Department of Public Health, talks about the extraordinary health of recent Latino immigrants and what we can all learn from them, the importance of hope, the power of community organizing, and why it's in all our best interest to tackle inequities sooner rather than later.

Image Thumbnail Asian Pacific Environmental Network E-mail to a friend
WEB SITE

"APEN seeks to empower low-income Asian Pacific Islander (API) communities to achieve environmental and social justice. APEN believes that the environment includes everything around us: where we live, work and play. And we strive to build grassroots organizations that will improve the health, well-being and political strength of our communities."

Image Thumbnail Austerity for Whom? E-mail to a friend
United for a Fair Economy

The latest report in  United for a Fair Economy's State of the Dream series, "Austerity for Whom?," surveys the impacts of a tax-cutting, government-shrinking economic agenda – as prescribed by Republican leadership with Tea Party allies – on communities of color.

 
We find that if such an agenda advances, the dream of a racially equal society, as described by Dr. Martin Luther King, Jr. over forty years ago, will be pushed even further out of reach.

Image Thumbnail Backgrounders on Health Equity Topics (pdf) E-mail to a friend
UNNATURAL CAUSES

This document by California Newsreel provides an overview of how social concerns such as income, jobs, education, housing, and racism relate to health outcomes and inequities. The short pieces in this document are taken from the topic introductions in the Health Equity database on the UNNATURAL CAUSES Web site.

Image Thumbnail Bay Area Regional Health Inequities Initiative (BARHII) E-mail to a friend
WEB SITE

BARHII is a unique undertaking by local health departments in the San Francisco Bay Area to confront health inequities, and recently released a report, Health Inequities in the Bay Area (pdf). The regional collaboration includes public health directors, health officers, senior managers and staff from Alameda, Contra Costa, Marin, San Francisco, San Mateo, Santa Clara and Solano counties, and the City of Berkeley. In addition to its work to help health departments learn from and teach each other, BARHII is developing regional strategies that supplement and support local work.

Image Thumbnail Bridging the Great Divide: Health Disparities in America E-mail to a friend
VIDEO - Kaiser Permanente

Kaiser Permanente's short video on health disparities presents some of the causes and costs of differences that result in poor health outcomes, and offers solutions to this nationwide problem. It includes more discussion of health care and insurance disparities than UNNATURAL CAUSES, but also mentions many of the social, environmental, and economic factors that generate health inequities.<br>
<br>Kaiser's Health Disparities site also includes other information and resources.

Image Thumbnail Building Stronger Communities for Better Health E-mail to a friend
REPORT from Health Policy Institute & Policy Link

This brief offers a framework for strengthening communities to improve the health and well-being of residents. One of four publications that outline strategies for achieving better health through community-focused solutions, this report is based on a review of the literature as well as on interviews with African American and Latino community health leaders (or those serving African American and Latino populations) and elected officials from across the country.

Image Thumbnail Bus Riders Union E-mail to a friend
WEB SITE

The Bus Riders Union, a project of the Labor/Community Strategy Center, is a progressive civil rights and environmental justice membership organization. Its work begins with the mass transit and public health needs of the Black community, the multiple communities of the African Diaspora, Latinoamericanos, Asian/Pacific Islanders, Indigenous communities, and working class whites who are transit dependent in Los Angeles. The Bus Riders Union seeks to promote environmentally sustainable public transportation for the entire population of Los Angeles, on the premise that affordable, efficient, and environmentally sound mass transit is a human right.

Image Thumbnail Capitalists, workers and health: Illness as a 'side-effect' of profit-making E-mail to a friend
SCHOLARLY ARTICLE, Graham Scambler, in Social Theory and Health, 2009

This brief and polemical paper suggests that one crucial but under-investigated generator of health inequalities in Britain is the strategic decision-making of the wealthy and powerful. It is argued that the post-1970s dynamic between class and state which underpins this decision-making has been largely ignored by medical sociology in favour of repeated studies of the poor and powerless.

(Subscription or purchase required)

Image Thumbnail Center on the Developing Child E-mail to a friend
WEBSITE

The Center on the Developing Child was founded in 2006 on the belief that the vitality and sustainability of any society depend on the extent to which it equalizes opportunities early in life for all children to achieve their full potential and engage in responsible and productive citizenship. They view healthy child development as the foundation of economic prosperity and strong communities, and our mission is to advance that vision by leveraging science to enhance child well-being.

The site includes a list of the Center's excellent publications.

Image Thumbnail Charts and State by State Data E-mail to a friend
RWJF Commission to Build a Healthier America

The Commission provides an in-depth collection of graphical data ready to download into relevant research and presentations on a range of issues from maternal education and infant mortality to income and life expectancy to placing the U.S. in a global context. Charts can be filtered by social factors or by health conditions.

Their State-by-State Data page allows for sorting charts by state and includes an Education and Health Calculator to compare your state to others.

Image Thumbnail Childhood socioeconomic status and adult health E-mail to a friend
Sheldon Cohen, Denise Janicki-Deverts, Edith Chen, and Karen A. Matthews

This article discusses the evidence supporting the link between childhood and adolescent SES and adult health, and explores different environmental, behavioral, and physiological pathways that might explain how early SES would influence adult health.  THe authors also address the ages when SES exposures matter most for setting adult health trajectories as well as the role of exposure duration in SES influences on later health. While early childhood exposures seem to be potent predictors of a range of health outcomes, the authors emphasize that later childhood and adolescent exposures are risks for other health outcomes.

Image Thumbnail Children Left Behind: How Metropolitan Areas Are Failing America's Children (pdf) E-mail to a friend
REPORT from DiversityData.org, January 2007

This report finds that across metropolitan America, black and Hispanic children face particularly severe challenges. Inequalities go far beyond what can be explained by income differences, as poor black and Hispanic children tend to encounter environments considerably worse than poor white and Asian children. Yet the very conditions that contribute to these inequalities suggest some possible policy solutions.

The analysis contained in this report is derived from diversitydata.org, a website using data from multiple sources to profile U.S. metropolitan areas's indicators on many dimensions of well-being, including housing, neighborhood conditions, residential integration, education and health.

Image Thumbnail Closing the Gap in a Generation E-mail to a friend
FINAL REPORT from Commission on the Social Determinants of Health

A project of the World Health Organization (WHO), the Commission on Social Determinants of Health (CSDH) supports countries and global health partners to address the social factors leading to ill health and inequities. It draws the attention of society to the social determinants of health that are known to be among the worst causes of poor health and inequalities between and within countries. The determinants include unemployment, unsafe workplaces, urban slums, globalization and lack of access to health systems. 

The Web site also contains final reports from the different knowledge networks, as well as additional background articles and resources.

Image Thumbnail College-Educated Fare Better When Cancer Strikes E-mail to a friend
NEWS ARTICLE, Steven Reinberg, HealthDay News, July 8, 2008

A report published July 8 in the Journal of the National Cancer Institute found that, while outcomes from the four leading cancers overall improved between 1993 and 2001, most of the decline in deaths occurred among men and women with college degrees. Among women with fewer than 12 years of education, only white women showed a signicant decline in mortality from breast cancer. The full report is available free online.

Image Thumbnail Crunch: Why Do I Feel So Squeezed? (And Other Unsolved Economic Mysteries) E-mail to a friend
BOOK by Jared Bernstein

"According to economist and author Bernstein, the endless parade of economic legislation and corporate criminality that keep the rich getting richer are all a direct product of economic knowledge being monopolized and manipulated by the rich, keeping the middle and lower classes woefully unprepared to understand, much less stand up to, the economic forces aligned against them. Fortunately, this accessible overview should clear things up for even the most befogged reader. Answering questions from an average American perspective-"the ones in the vise grip of the crunch"-Bernstein explains murky topics like health care reform, minimum wage laws, the Federal Reserve, immigration and budget deficits with a clear, friendly manner that sidesteps any scholarly (and/or sinister) obfuscation. His progressive "we're all in this together" philosophy, though seemingly familiar, is backed up with enough data and savvy to illuminate what's wrong in the dominant "self-reliance" narrative of American political discourse. This down-to-earth, populist guide to the pressing economic issues of our time is a clarifying, useful and empowering resource." - Publishers Weekly

Image Thumbnail Data Set Directory of Social Determinants of Health at the Local Level (pdf) E-mail to a friend
DATA SETS  REFERENCE, Social Determinants of Health Work Group at the Centers for Disease Control and Prevention

The directory contains an extensive list of existing data sets that can be used to address the need for improved conceptualization and availability of data on how the social environment impacts the health of populations. The data sets are organized according to 12 dimensions, or broad categories, of the social environment. Each dimension is subdivided into various components.

This directory grew out of a project based at the University of Michigan School of Public Health and funded by the Centers for Disease Control and Prevention (CDC).

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